Appeals and Grievance Specialist

This is a fully remote position, open to applicants in United States.

📋 Description

• Oversee and address complaints, grievances, and appeals from both members and providers.

• Act as the main point of contact throughout the investigation and resolution phases.

• Dispatch acknowledgments and offer comprehensive education on the grievance and appeal procedures.

• Collect pertinent information and investigate case specifics to identify suitable resolutions.

• Execute fair, precise, and timely investigations of cases.

• Relay resolutions to relevant internal and external stakeholders.

• Ensure completion and maintenance of all necessary documentation.

• Adhere to established policies, procedures, and regulatory standards.

• Uphold productivity and quality benchmarks in a structured workflow setting.

• Participate on camera during interviews, training sessions, team meetings, and routine check-ins.

⛳️ Requirements

• Minimum of 1 year of experience with Medicare Appeals and Grievances or Medicare Claims is mandatory.

• Prior experience with Medicare Part C or Part D is preferred.

• Proficient with Windows-based computer systems and capable of learning new software applications.

• Strong technical skills and proficiency in keyboarding.

• Exceptional verbal and written communication abilities.

• Capacity to maintain focus and productivity in repetitive task-oriented roles.

• High School Diploma or equivalent is required.

• Availability to work a schedule from Monday to Friday, 8:00 AM to 5:00 PM Pacific Time, according to business needs.

• Must appear on camera during interviews, training, team meetings, and regular check-ins.

• Background checks, employment verifications, and educational verifications may be conducted.

🏝️ Benefits

• Weekly pay.

• Comprehensive Medical, Dental, and Vision insurance.

• Life Insurance coverage.

• Options for Short-Term and Long-Term Disability.

• Flexible Spending Account (FSA).

• Employee Assistance Program.

• 401(k) plan with employer contributions.

• Paid Time Off (PTO).

• Tuition Reimbursement.

• Opportunity for remote work arrangements.